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General NPI Number Information
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NPI Number | 1700080819
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Entity Type | Organization
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Legal Business Name | KEARNS PHYSICAL THERAPY LLC
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 107 CREEKROCK CIR
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-8037
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Country | US
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Telephone | 859-401-2941
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Fax |
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Provider Business Mailing Address
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Address Line | 107 CREEKROCK CIR
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-8037
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Country | US
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Telephone | 859-401-2941
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. ELISE K WATSON
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Credential | PT
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Telephone | 859-401-2941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 004930
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License Number State | KY
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